MedicaidPrior AuthHigh impact
[Virginia] LTSS Authorization and CC Guide
Anthem BCBS·VA · Geriatrics, Palliative Care, Occupational Therapy +1 more·Provider Bulletin
Effective date
May 5, 2026
We identified it
May 6, 2026
Summary
HealthKeepers, Inc. (Anthem) released an updated Long-Term Services and Supports (LTSS) Authorization Guide for Virginia Medicaid providers, effective May 5, 2026. The guide clarifies prior authorization requirements, documentation standards, submission methods, and turnaround times for LTSS services including personal care, adult day health, PERS, and private duty nursing. Providers must align with these requirements to avoid claim denials and ensure timely approvals.
Action Required
By June 30, 2026: Billing team must obtain and review the full LTSS Authorization Guide from HealthKeepers, Inc. via the provided link (https://providernews.anthem.com/virginia/articles/updated-ltss-authorization-guide-for-medicaid-providers-avoi-29829). Update internal authorization workflows and training to reflect: (1) required documentation for continuity of care and new/renewal authorization requests; (2) correct submission methods; (3) standard vs. expedited request criteria; (4) turnaround time expectations. Front desk and billing staff must implement checklist procedures to verify complete documentation before submission, coordinate with care managers for renewals/service changes, and avoid duplicate requests. Update encounter templates and billing system instructions to reflect LTSS authorization requirements. Providers must ensure compliance to prevent claim denials for ineligible reimbursements and authorization lapses.